Provider Demographics
NPI:1790022952
Name:CARLSON, RITA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:A
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SHADY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-6364
Mailing Address - Country:US
Mailing Address - Phone:775-315-2980
Mailing Address - Fax:
Practice Address - Street 1:1201 TERMINAL WAY STE 111
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3398
Practice Address - Country:US
Practice Address - Phone:775-657-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0903103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical